With more people becoming eligible for Medicaid, one question repeatedly comes up: “will receiving Medicaid coverage jeopardize my family home?” Depending on the circumstances, the answer can be complicated. But states can do much to make it less complex.

The fact is that states can recover against the estates of some Medicaid beneficiaries, but only after the beneficiary passes away, and only in certain circumstances. Federal law actually requires that states try to recover from the estates of Medicaid beneficiaries who received nursing facility services and/or home and community-based services when they were age 55 or older. In other words, federal law sets the floor for Medicaid estate recovery by states.

Complicating matters is that states have the option to recover for more than what is federally required. States may recover from individuals age 55 and older for any items or services covered under the state’s Medicaid plan. California is one of just a few states that has taken the option to recover for all covered services provided to individuals age 55 and older. Currently, a bill is moving through the state legislature to limit recovery to only what is federally required. Last year, a similar bill received unanimous support from the California legislature, but was vetoed by the governor due to budgetary concerns.

It is important to keep in mind that there are exceptions to when a state can recover and from whom it can do so. For example, Medicaid estate recovery cannot occur during the lifetime of a surviving spouse or when there is a surviving child under age 21 or a blind or disabled child of any age. Also, states must establish procedures for waiving estate recovery when it would cause an undue hardship. Yet many states do not have clear undue hardship policies, leading to increased denials and making it difficult for family members to figure out who qualifies for a hardship waiver and in which circumstances.

State policy makers should also realize that, for the next couple of years, states will not keep recovered claims for the Medicaid expansion population and after 2016 will still keep only a small amount. When states recover from the estates of former Medicaid beneficiaries, they return to the federal government the portion that represents the federal share of expenditures on an individual’s Medicaid covered services. Since services provided to the Medicaid adult expansion population are 100 percent federally funded for the first three years (2014-16), and almost fully federally funded thereafter, states will have to return to the federal government the full amount collected (and in future years close to the full amount). States are essentially serving as a collection agency for the federal government.

Many have identified estate recovery rules as a potential barrier to enrollment in Medicaid. Individuals may be hesitant to enroll in Medicaid because they own a home that they want to leave to their adult children when they pass away. Advocates must urge states to limit estate recovery to what is federally required, and advocate for clear exceptions policies to ensure that individuals and families feel comfortable enrolling in Medicaid and getting the care that they need.

There are no guarantees when it comes to aging, but a new study helps clarify the lifestyle choices that affect our risk for Alzheimer’s disease, for better and for worse. The team from the University of California, San Francisco culled thousands of previous studies on Alzheimer’s risk and protective factors, and arrived at 323 studies that provided high-quality data. They found, as other studies have, that there are some key elements that are largely within our power to integrate or avoid, in order to reduce the risk of the brain disease that affects some 5 million people in the U.S. today.
The factors that appear to be protective against Alzheimer’s include many of the things that we already know to be good for us: Eating a healthy diet; healthy intake of folate, vitamin C, and vitamin E; coffee consumption; fish consumption; light-moderate drinking; and staying cognitively active. There were also some links between medications and reduced Alzheimer’s risk, including estrogen, cholesterol lowering drugs (statins), blood pressure meds, and anti-inflammatory drugs (NSAIDs).
The nine factors associated with higher risk of developing Alzheimer’s were:
• Obesity
• Depression
• Carotid artery narrowing
• Low educational attainment
• High levels of homocysteine (a compound that builds up, in part when B vitamin levels are low)
• High blood pressure and low blood pressure
• Frailty
• Current smoking (in the Asian population)
• Type 2 diabetes (in the Asian population)

Many of the connections have been known for some time, but it’s helpful to have them confirmed by newer, large-scale analyses. Keep in mind, of course, that the study only arrives at correlations between these factors and Alzheimer’s – it doesn’t prove that one or more actually cause or prevent the other. And genetic factors still play a strong role in the development of Alzheimer’s. But the researchers say that assuming causality is at play, if the population avoided the nine risk factors listed above, up to two-thirds of Alzheimer’s cases could also be avoided. That’s quite a high percentage. We may not be able to do all good things for ourselves all the time, but when it comes to the brain, the more we can do, the better.

Most Medicare enrollees can expect to pay the same amount for their Medicare Part B coverage (the portion of Medicare that pays for doctors’ services and outpatient care) in 2016 as they do this year ($104.90), according to estimates from the latest Medicare trustees report. But about 1 in 7 enrollees will face a dramatic increase. In 2016, about 70 percent of Medicare enrollees will be protected from an increase because of a “hold harmless” provision in federal law that says their Medicare premium cannot go up from one year to the next by more than the increase in their Social Security benefit. Government officials currently estimate there will be no cost-of-living increase in Social Security benefits next year because inflation has been so low. For about 30 percent of Medicare enrollees, premiums are expected to rise steeply. About 14 percent of enrollees will pay these premiums themselves. The rest will not be directly affected because they are enrolled in Medicaid or a Medicare Savings Program and their premiums are paid by their state. Three groups will see increases:
• People who newly enroll in Part B in 2016 (about 5 percent of Medicare enrollees);
• Medicare enrollees who do not receive a Social Security check — for example, enrollees who delay claiming Social Security benefits because they continue to work (about 3 percent of Medicare enrollees); and
• Higher-income enrollees (people with income above $85,000 or couples with income above $170,000) who pay higher premiums (about 6 percent of Medicare enrollees)

For these enrollees not protected by the hold harmless provision, the Part B standard monthly premium will be $159.30 in 2016, a 52 percent increase. Higher-income enrollees who pay higher premiums will also see a 52 percent increase; their 2016 monthly premiums will be between $223 and $509.80, depending on income. The rise is especially steep because the total increase in premium revenue required in 2016 will be spread among only the 30 percent of enrollees who are not protected by the hold harmless provision, rather than among all enrollees.

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Peter Losavio of Losavio & DeJean will be presenting five (5) free seminars entitled “Don’t Go Broke in a Nursing Home”. This seminar will provide information regarding long term and crisis planning for you or your loved one’s nursing care needs. If you wish to attend, please call 1-800- 426-6104. Attendees will receive a free book co-written by Peter Losavio as well as free telephone consultations and a discounted initial office conference. The schedule for these five (5) free seminars are as follows:

Tuesday July 21, 2015 at 4:00 pm at the East Baton Rouge Library on Bluebonnet Blvd, Baton Rouge, La.;

Saturday July 25, 2015 at 10:00 am at the East Baton Rouge Library on Bluebonnet Blvd, Baton Rouge, La.;

Tuesday July 28, 2015 at 4:00 pm at the East Baton Rouge Library on Goodwood Blvd, Baton Rouge, La.;

Thursday July 30, 2015 at 4:00 pm at the East Baton Rouge Library on Goodwood Blvd, Baton Rouge, La.;and

Saturday August 1, 2015 at 10:00 am at the East Baton Rouge Library on Goodwood Blvd, Baton Rouge, La..

Mr. Pete Losavio will be speaking at a free workshop at Sunrise of Baton Rouge 8502 Jefferson Hwy. Baton Rouge, LA 70809 on Saturday June 27, 2015 at 9:30 am to discuss his new book he co-authored ” Don’t Go Broke in a Nursing Home”. Please call 1-880-426-6104 to attend.